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Midodrine with albumin does not prevent cirrhosis complications

Treatment with midodrine and albumin mildly suppressed the activity of vasoconstrictor systems in patients with cirrhosis waiting for liver transplantation but did not significantly prevent cirrhosis complications or improve survival, according to recently published data.

“Treatment with midodrine and albumin was not effective compared to placebo,” Elsa Solà, MD, from the University of Barcelona in Spain, and colleagues wrote. “However, treatment with midodrine and albumin attenuated the severity of complications related to kidney dysfunction, because renal failure and hyponatremia episodes were less intense in patients from the midodrine and albumin group.”

The study comprised 87 patients who received the combination midodrine and albumin therapy and 86 patients in a placebo group. Median duration of study treatment was 80 days with nine patients in the treatment group and 20 patients in the placebo group completing the 1-year study.

During follow-up, 32 patients from the treatment group and 37 patients from the placebo group developed at least one cirrhosis-related complication, such as renal failure, bacterial infections, hyponatremia, hepatic encephalopathy or GI bleeding.

Compared with the placebo group, treatment with midodrine and albumin did not correlate with significant improvement of ascites, changes in mean arterial pressure, probability of transplant-free survival, or the development of adverse events.

While there were no significant differences in the incidence of complications between the two groups, episodes of hyponatremia and renal failure were more severe among the placebo group.

Additionally, while mean arterial pressure did not change significantly during follow-up for either group, treatment with midodrine and album correlated with a slight but significant decrease in plasma renin activity (4.3 vs 0.1 ng/mL; P < .001) and aldosterone (38 vs. 6 ng/dL; P = .02) at 48 weeks compared with placebo.

“There is an unmet need for effective strategies to prevent the development of complications in patients with decompensated cirrhosis, particularly those on the waiting list for LT, in order to improve outcomes and increase the probability of reaching LT,” Solà and colleagues wrote. “Further studies in large patient populations are needed to evaluate the role of chronic albumin administration as therapeutic approach to prevent complications and improve survival in cirrhosis.” – by Talitha Bennett

Disclosure: Solà reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.